초록접수 현황
| 20F-036 | 구연 발표 |
Outcomes of massive pulmonary thromboembolism treated with intensive critical care including ECMO without thrombolytic therapy or surgical embolectomy
Hyung Tae Sim, Min Seop Jo, Yong Jin Chang, Deog Gon Cho, Kyu Do Cho
Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University College of Medicine, Suwon, Gyeonggi-do, Republic of Korea
Purpose : Massive pulmonary thromboembolism (PTE) is a fatal illness that causes hemodynamic instability and circulatory collapse. Systemic thrombolytic therapy is a standard treatment, but it is often ineffective in patients with circulatory collapse and there are also serious bleeding complications. Surgical embolectomy is an another treatment option, but it has a high mortality rate and is controversial over whether it is absolutely necessary. We sought to evaluate the outcomes of massive PTE treated with intensive critical care including ECMO without thrombolytic therapy or surgical embolectomy.
Methods : We analyzed 39 patients who were treated for massive PTE from January 2011 to June 2019. The treatment of massive PTE was systemic anticoagulation with heparin and hemodynamic support under close monitoring at intensive care unit. Extracorporeal membrane oxygenation (ECMO) was applied without thrombolytic therapy in patients with circulatory collapse. CT obstruction score and RV/LV ratio were measured using serial CT angiography to confirm changes in pulmonary embolus and RV strain. (Fig. 1).
Results : All patients showed unstable hemodynamics and initial mean systolic blood pressure and heart rate was 82 ± 39 mmHg and 93 ± 42 beat/min. Right ventricular dysfunction on echocardiography was observed in all patients. Sixteen patients were in cardiogenic shock initially, and 13 of them needed cardiopulmonary resuscitation (CPR). Five patients developed cardiogenic shock during intensive treatment (Fig 2). Fifteen patients were treated with ECMO and 9 of them (60%) weaned off successfully and long term survived without any sequela. Overall in-hospital mortality was 23% (9/39). There were no late deaths. All survivors were able to follow up and the median follow-up duration was 787 days (range 186 - 2855). Initial median CT obstruction score was 32 (range 14 – 38). On follow- up CT scan after 6 months, residual PTE was observed in 10 patients and their median CT obstruction score was 2.5 (range 1 – 14). Initial mean RV/LV ratio was 1.8 ± 0.47 and the value measured by follow-up CT decreased to less than 1 (0.9 ± 0.1). All survivors showed NYHA class I or II functional status and chronic thromboembolic pulmonary hypertension (CTEPH) was observed in only one patient.
Conclusion : Massive PTE was treated with anticoagulation alone, without thrombolytic therapy or surgical embolectomy. Most of the PTE was regressed completely, and CTEPH was rarely developed. Intensive critical care and timely ECMO support could be effective treatment options for massive PTE.
Methods : We analyzed 39 patients who were treated for massive PTE from January 2011 to June 2019. The treatment of massive PTE was systemic anticoagulation with heparin and hemodynamic support under close monitoring at intensive care unit. Extracorporeal membrane oxygenation (ECMO) was applied without thrombolytic therapy in patients with circulatory collapse. CT obstruction score and RV/LV ratio were measured using serial CT angiography to confirm changes in pulmonary embolus and RV strain. (Fig. 1).
Results : All patients showed unstable hemodynamics and initial mean systolic blood pressure and heart rate was 82 ± 39 mmHg and 93 ± 42 beat/min. Right ventricular dysfunction on echocardiography was observed in all patients. Sixteen patients were in cardiogenic shock initially, and 13 of them needed cardiopulmonary resuscitation (CPR). Five patients developed cardiogenic shock during intensive treatment (Fig 2). Fifteen patients were treated with ECMO and 9 of them (60%) weaned off successfully and long term survived without any sequela. Overall in-hospital mortality was 23% (9/39). There were no late deaths. All survivors were able to follow up and the median follow-up duration was 787 days (range 186 - 2855). Initial median CT obstruction score was 32 (range 14 – 38). On follow- up CT scan after 6 months, residual PTE was observed in 10 patients and their median CT obstruction score was 2.5 (range 1 – 14). Initial mean RV/LV ratio was 1.8 ± 0.47 and the value measured by follow-up CT decreased to less than 1 (0.9 ± 0.1). All survivors showed NYHA class I or II functional status and chronic thromboembolic pulmonary hypertension (CTEPH) was observed in only one patient.
Conclusion : Massive PTE was treated with anticoagulation alone, without thrombolytic therapy or surgical embolectomy. Most of the PTE was regressed completely, and CTEPH was rarely developed. Intensive critical care and timely ECMO support could be effective treatment options for massive PTE.
첨부파일 : Figure.pptx
책임저자: Hyung Tae Sim
Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University College of Medicine, Suwon, Gyeonggi-do, Republic of Korea
발표자: Hyung Tae Sim, E-mail : artistsim@naver.com